SAT0239 LONG TERM OUTCOMES IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME AND RENAL ARTERY STENOSIS

<jats:sec><jats:title>Background:</jats:title><jats:p>Antiphospholipid syndrome (APS) is characterized by thrombosis and obstetric morbidity in the context of positive antiphospholipid antibody markers. More than a quarter of hypertensive APS patients (26%) have renal artery stenosis (RAS) (1). Treatment includes anticoagulation, blood pressure control and management of cardiovascular risks. In some cases, the severity of the renal vascular lesion requires surgical intervention</jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p>To evaluate long term outcomes in APS patients with RAS.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>Retrospective database study. All records of APS patients with RAS were analyzed and demographic variables, comorbidities, treatment received, renal outcome and mortality were recorded.</jats:p><jats:p>Uni- and multivariate analyses were performed by logistic regression with death and chronic kidney disease (CKD) as dependent variables. In the multivariate analysis, the covariates considered were age at diagnosis of stenosis, diabetes, smoking, dyslipidemia, unilateral or bilateral stenosis, stenosis greater than 50%, surgery and the use of immunosuppressants, anticoagulation and statins.</jats:p><jats:p>Research and development office has approved this study.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>33 RAS patients were analyzed. Diagnosis of RAS was made by MRI renal angiography and in some cases by CT angiogram and intra-arterial digital subtraction angiography. Patient characteristics are detailed in Table 1. The median duration of follow-up was 152 months (IQR 65).</jats:p><jats:table-wrap position="float" orientation="portrait"><jats:label>Table 1.</jats:label><jats:caption><jats:p>Patient Characteristics.</jats:p></jats:caption><jats:table><jats:thead><jats:tr><jats:th align="center" rowspan="1" colspan="1" /></jats:tr></jats:thead><jats:tbody><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>N° Patients</jats:bold>33</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Age median</jats:bold>48 (IQR 16)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Smokers%</jats:bold>18.1(6)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Comorbidities %</jats:bold></jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">Diabetes mellitus type 2 6 (2) Hypertension 100(33)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">High LDL 36.3(12)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Primary APS %</jats:bold>39.4 (13)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Secondary APS %</jats:bold>60.6 (20)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Unilateral RAS%</jats:bold>75.8 (25)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Bilateral RAS%</jats:bold>24.2 (8)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Degree of stenosis</jats:bold></jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">&lt; 30% 15.1 (5)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">30-50% 30.3 (10)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">50-80% 33.3 (11)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">&gt;80% 21.2 (7)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1"><jats:bold>Treatment%</jats:bold></jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">Medical treatment 75.7 (25)</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">Surgical treatment 30.3 (10)</jats:td></jats:tr></jats:tbody></jats:table></jats:table-wrap><jats:p>Renal biopsy was performed in 3 patients: crescentic glomerulonephritis was found in 2 patients and one had a thrombotic microangiopathy.</jats:p><jats:p>Treatment: 25 patients (75.7%) were anticoagulated with vitamin K antagonists, 19 (57.6%) received immunosuppressive therapies, 18 (54.5%) were on statins. Ten patients (30.3%) were managed surgically with balloon angioplasty. Restenosis occurred in 4/10 patients (40%) and percutaneous renal artery stenting was performed successfully in all four. Ten patients died (30.3%). Renal outcomes are shown in Table 2.</jats:p><jats:table-wrap position="float" orientation="portrait"><jats:label>Table 2.</jats:label><jats:caption><jats:p>Outcome in APS with RAS Patients</jats:p></jats:caption><jats:table><jats:thead><jats:tr><jats:th align="center" rowspan="1" colspan="1" /></jats:tr></jats:thead><jats:tbody><jats:tr><jats:td align="left" rowspan="1" colspan="1">N %</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">Died 10 30.3</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">Transplanted 1 3</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">Renal Dysfunction 17 51.5</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">CKD Stage III 10 30.3</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">CKD Stage IV 4 12.1</jats:td></jats:tr><jats:tr><jats:td align="left" rowspan="1" colspan="1">CKD Stage V 3 9</jats:td></jats:tr></jats:tbody></jats:table></jats:table-wrap><jats:p>In the univariate analysis, surgery was significantly associated with a lower probability of reaching CKD (p=0.042; OR 0.2; 95% CI 0.03-0.94). In the multivariate analysis, the tendency to benefit from surgery was maintained but the statistical significance was lost, probably due to the low number of patients.</jats:p><jats:p>In the subgroup analysis, the tendency to benefit from surgery was maintained in patients with or without anticoagulation, immunosuppressants, statins, with primary or secondary APS, with uni- or bilateral stenosis, with or without dyslipidemia, but this benefit was lost in smokers independent of the grade of stenosis.</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>RAS is a treatable cause of hypertension and a poor prognostic marker in APS patients.</jats:p><jats:p>In this study, APS patients with RAS who underwent intervention with angioplasty or stenting had a trend to a lower probability of developing CKD in contrast to studies in atherosclerotic RAS. The beneficial effect of surgery was lost in smoking patients. In this relatively young population mortality was high.</jats:p></jats:sec><jats:sec><jats:title>References:</jats:title><jats:p>[1]Sangle SR, D’Cruz DP, Abbs IC, Khamashta MA, Hughes GR. Renal artery stenosis in hypertensive patients with antiphospholipid (Hughes) syndrome: outcome following anticoagulation. Rheumatology (Oxford) (2005) 44:372–7.</jats:p></jats:sec><jats:sec><jats:title>Disclosure of Interests:</jats:title><jats:p>María José Villar: None declared, Shirish Sangle: None declared, Sebastian Ibáñez Consultant of: Novartis, Paid instructor for: Bristol Myers, Speakers bureau: Abbvie, David d’cruz Grant/research support from: GlaxoSmithKline</jats:p></jats:sec>